Healthcare Provider Details

I. General information

NPI: 1710299532
Provider Name (Legal Business Name): BRENDA J HOFFNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE STE A721
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3139
  • Fax: 616-391-3044
Mailing address:
  • Phone: 616-486-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number47166734
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: